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Breast Cancer Oncotype Testing Medical Necessity Criteria

Approved: 1/09
Reviewed: 3/10, 2/11, 1/12, 3/14, 2/15, 1/16, 1/17
Revised:  1/13

 

Breast cancer oncotype testing quantifies the risk of breast cancer recurrence in women with newly diagnosed, Stage I or II, node negative, estrogen receptor positive breast cancer who will be treated with Tamoxifen.  The following guidelines are used when considering oncotype testing requests:

  1. The cancer is not metastatic beyond three regional nodes.

  2. The tumor is estrogen receptorpositive and or progesterone receptor positive.

  3. The tumor is HER2 receptor negative.

  4. Adjuvant chemotherapy is not precluded due to other conditions such as advanced age or co-morbidities.

  5. The patient and physician have discussed the value, limitations, and implications of the test.

ConnectCare

Utilization Management

ConnectCare's Utilization Management Staff is available to address questions and issues related to case management and utilization by using the telephone or fax numbers listed below.

ConnectCare Medical Management
4000 Wellness Drive
Midland, MI 48670
Toll free: 888-646-2429
Local: 989-839-1613
Fax: 989-839-1679
 
Hours of Operation
8:00 a.m. - 12:00 p.m.
1:00 p.m. - 5:00 p.m.
Monday - Friday (Eastern Time)

After normal business hours, inbound communications and information may be relayed via fax, confidential voice mail or electronic mail. All precertification requests and/or communications received after normal business hours are returned on the next business day and communications received after midnight on Monday through Friday are responded to on the same business day.